Access to Health Care

These publications emphasize access to health care, especially for low and middle-income individuals. Initiatives to reduce health disparities coincides with access and utilization of health services, including but not limited to  universal healthcare initiatives.

The Public-Private Option in Germany and Australia: Lessons for the United States

By Richard M. Scheffler and Taylor L. Wang | Published September 21, 2020 in Milbank Quarterly Opinion | Link to Full Article

There is little doubt that the cost of health care and universal coverage will be a major topic discussed at the upcoming presidential debates. A key debate will likely center on the Biden-Sanders Unity Task Force’s recommendations released earlier this year proposing a public option to compete against existing private insurers. The recommendations only outline a public option framework, so the details, both logistical and financial, will be key to moving forward. While recent articles have assessed the state-level public options in Washington State and New Mexico, we look internationally to Germany and Australia to evaluate how their health care systems have achieved universal coverage by delivering public health insurance. Both countries have a private component in the health insurance system: Germany allows individuals to purchase substitutive private insurance based on income, and Australia takes it a step further by creating incentives for all citizens to enroll in supplemental private insurance. We examine the framework of each system, how the public-private insurance dichotomy is organized, and some key takeaways for the United States.

The Public Option: From Hacker to Biden

By Richard M. Scheffler and Taylor L. Wang | Published September 21, 2020 | Link to Full Article

Presidential candidate Joe Biden’s proposal for a public option is likely to be a major topic in the upcoming presidential debate. While the proposal certainly isn’t the first of its kind, in light of the recent COVID-19 pandemic it is especially significant due to the rapid increase in the number of people without insurance. To better understand the arguments for this proposal and other public option or opt out proposals, we discuss the following: (1) Jacob Hacker’s original ideas and arguments for a public option and why it was left out of the ACA, (2) A review of the cost and coverage impacts of various public option reforms conducted by the Urban Institute, (3) An examination of the only state-based public option passed by Washington State, (4) The current version of Biden’s public option, and (5) Final thoughts.

Sustaining Universal Coverage Through California’s Integrated Care Delivery System

By Stephen M. Shortell, Richard M. Scheffler, Shivi Anand, and Daniel Arnold | Published May 8, 2019 | Link to Report

This Brief highlights 1) California’s comparative advantage in having a large number of integrated care model physician organizations; 2) provides evidence on their ability to provide lower cost, higher quality value-based care; and 3) proposes a plan for expanding such models across the state to meet the ongoing needs and preferences of all Californians that will have universal health insurance coverage.

The Seven Percent Solution: Costing and Financing Universal Health Coverage in California

By Richard M. Scheffler and Stephen M. Shortell | Published February 24, 2019 | Link to Full Report

As of 2017, California’s uninsured rate stands at just over 7 percent. Moving towards universal health coverage in California for the 3.72 million projected to be uninsured in 2020, of which about 1.5 million are undocumented, is a significant challenge but has considerable benefits. A healthier workforce will be more productive and absenteeism will decline.4 Moreover, taxes collected from these healthier workers will increase. All Californians will have their risk of disease lowered. Universal coverage will allow all Californians to have improved access to care so they can prevent and treat illnesses that can be passed on to others. Children will have a better start to life and there will be less absenteeism in schools. In addition, the expensive treatment in emergency rooms would surely decline. Beyond these benefits for all Californians, it is the right thing to do. Most Californians support universal coverage, but have reservations about the cost of doing so.

Covered California: A Progress Report

By Richard M. Scheffler and Jessica Foster | Published January 31, 2014 by the Petris Center | Link to Full Report

In its first several months of open enrollment, Covered California despite its challenges has been a bright spot among state health insurance Exchanges created under the Affordable Care Act. About 23% of national enrollments in 2013 came from California. More than 1.4 million California residents have completed Covered California applications, more than 625,000 people have enrolled in subsidized or unsubsidized health plans, and more than 1.2 million are expected to be newly enrolled in Medi-Cal. Though it experienced a slow start in October, Covered California by the end of the year had surpassed its enrollment goal for the first half of open enrollment. This report provides a summary of the Covered California rollout, including a breakdown of application and enrollment trends, plan affordability and cost estimations, and questions and concerns for future analysis.

The Labor Market for Health Workers in Africa: A New Look at the Crisis

Edited by Agnes Soucat, Richard M. Scheffler, with Tedros Adhanom Ghebreyesus | Published April 2013 by the World Bank Group | Link to Full Book

Addressing the challenge of decent healthcare and education for low-income families is critical to building the human capital that African countries need to sustain economic growth in the years ahead. Within this broad goal, specific challenges linked to Human Resources for Health (HRH) in Africa must be addressed to achieve stronger health systems, universal access to health services, and greater improvements in actual health outcomes. Today, it is widely recognized among Ministries of Health and development partners that the overall availability, distribution, and performance of health workers in Africa must be rapidly improved.

Is There a Doctor in the House? Market Signals and Tomorrow’s Supply of Doctors

By Richard M. Scheffler | Published in 2008 by Stanford University Press | Link to Book Website

This book explores American’s bedrock healthcare concern – “Will there be a doctor―a good doctor―when I need one?” In this concise and readable analysis, Scheffler goes beyond the guessing game to demonstrate that today’s health care system is the product of financial influences in both the policy realm and on the ground in the offices of medical centers, HMOs, insurers, and physicians throughout America. He shows how factors such as physician income, medical training costs, and new technologies affect the specialties and geographic distribution of doctors. As part of his vision of tomorrow’s ideal workforce, he offers a template for enhancing the efficiency and cost-effectiveness of the health care system overall. In the groundbreaking second half of the book, Scheffler tests his ideas in conversations with leading figures in health policy, medical education, health economics, and physician practice. Their unguarded give-and-take offers a window on the best thinking currently available anywhere.

Consumer-Driven Health Plans: New Developments and the Long Road Ahead

By Richard M. Scheffler and Mistique C. Felton | Published July 2006 in Business Economics | Link to Full Article

The continued rise in U.S. healthcare spending, along with growth in the number of uninsured, has spurred the move toward consumer-driven health plans. This article reviews new legislation covering such plans, analyze their penetration in the marketplace, and predict their growth. We also use current information about plans that are compatible with Health Savings Accounts to compare them to traditional Preferred Provider Organization plans. Next, we discuss some concerns about the impact of these plans on vulnerable populations, such as the poor and sick. Finally, we suggest how consumer-driven health plans may help to improve the functioning of the healthcare market, especially by producing more transparent information on cost and quality.